Helen,
I can confirm what Karleen and Jean say. Sulpiride was very commonly
used as a galactogogue in Southern Africa. It's actually a mild
antidepressant, and a psycho-normaliser as well as an antipsychotic,
and works by increasing prolactin levels (the hormone we all produce
when stressed!). It is not indicated for increasing breastmilk
production, but the doctors, OBs and paeds in Zimbabwe knew that it
worked for this purpose and prescribed it a lot. I did a mini-survey
once of my own clients, and found that a full 23% of them had been
prescribed this drug either in the current or a previous
lactation. So I've worked with literally hundreds of women who took
it. I did find that it was rather over-used by the doctors to "fix"
almost any breastfeeding problem where the mother might be concerned
whether she was making enough milk, and often without a proper
investigation of the cause of low milk supply, and it was usually
prescribed for two weeks and then abruptly discontinued. It seemed
to take about 4 days to start working, when the mother would then
happily notice an increase in breastmilk production. However, at the
end of the 2 weeks, sudden withdrawal caused a sharp _drop_ in
supply, again about 4 days after the last dose. The mothers would
become very discouraged at that point, thinking that even sulpiride
didn't help them.
However, I found this drug amazingly effective if the original cause
of not-enough-milk was addressed (ineffective breastfeeding by the
baby, stringing the feeding times out by the mother) and if the
mother was willing to take other measures to increase her milk
production as well (breastfeeding much more often, expressing the
milk left behind at the end of feeding and using this as a top-up for
the baby). The doctors were willing to prescribe a second or third
course, and some mothers took it for months. Once the breastfeeding
was going well and the baby was gaining weight appropriately I found
it helpful to suggest that the mother ask her doctor if he would
agree to tapering off gradually, reducing from 3 x 50 mg/24 hours, to
twice, then to once, before stopping altogether. I did find that
some mothers became psychologically hooked on it, and I used to
address this with lots of hand-holding and confidence building as the
mother stopped taking it, but I don't believe that there is any
possibility of physical addiction.
Sulpiride was so well known that nearly all the mothers I worked with
knew about it, and would cadge pills from their friends, who would
gladly share it - which was disastrous. Consequently I eventually
developed a handout outlining what I observed, to give to all my
clients who had been prescribed sulpiride, in the hope that they
wouldn't pop pills on a bad day and take none on a good day, or hand
them out to their sisters/friends/cousins... and with the caution
that they should always seek medical advice before changing the way
they took this medication. I kept in touch with the doctors too, of
course, and shared my observations with them. Let me know if you
want a copy. As I say, I found sulpiride to be a really useful
medication for increasing breastmilk production. The other usual
methods will work too, of course, and most often it's _not_
needed. But when a situation is quite fraught then I found that
sulpiride gives _quicker_ results. I found that in cases of
inadequate glandular tissue or - say - post-partum haemorrhage -
sulpiride was not enough to bring in a full milk supply - but what it
did seem to do was to maximize production of what little milk was
being produced. It also kept the mother feeling calm and encouraged
and hopeful during a difficult situation - because it's a mild
antidepressant. It was also extremely useful for a mother inducing
lactation from scratch (adoptive nursing) or relactating after an
interval of a few days to a few months.
I know this drug is not used in the UK or the US for help with
lactation, and there is a lot of concern about it, as Karleen
reflects. But because it was so very commonly prescribed to my
clients, with babies of all ages, including pre-term babies, and
because it worked so well and seemed to cause no side-effects that I
heard reported, then I can't really understand the paranoia about
it. If your client's medical advisors have any colleagues in
Southern Africa, it might be worth making the gentle suggestion that
they might consider obtaining their opinion and reassurance.
Pamela Morrison IBCLC
Rustington, England
--------------------------------------------
Subject: Non-domperidon prolactine stimulation?
From: [log in to unmask]
Date: 06/01/2010 2:12 pm
Hi,
Case: a mother who is looking for information how to stimulate her
milk production, but
without using domperidon. She gave me permission to post her question here.
Mother has hypoplastic tubular breasts and went through quite some
trouble to nurse her first
3 children. She used high doses of domperidon and needed about 300 ml
donormilk in a
SNS to feed her children adequately. Baby would lose interest in
breast if she didn't
supplement with SNS because of low milkflow.
She is planning to try to conceive later this year and is not looking
forward to using
domperidon again because it makes her hungry all the time and she
gains lots of weight as
well (from eating more).
She is wondering if there is another way to stimulate prolactine,
apart from domperidon.
--
Heleen Hayes, http://www.xs4all.nl/~hhayes
---------------------------
But Karleen says, "There's a load of drugs that increase prolactin
secretion but many of them are drugs for psychiatric conditions and I
wouldn't been keen on taking
them! There's a drug commonly used in Africa- can't remember the
name off the top of my head but I'm sure that one of our African
Lactnetter will supply it."
Karleen Gribble
Australia
And Jean says, " The most common drug (mis)used in South Africa to
enhance lactation is supiride (an anti-psychotic). Metaclopramide
is also used."
Jean Ridler RN RM IBCLC
South Africa [log in to unmask]
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